Critical appraisal of simulated patient methodology to assess the practice of community pharmacist in the Middle East and North Africa region: A systematic review

Main Article Content


Simulated patient, Community pharmacy, The Middle East and North Africa


Background: The use of simulated patient (SP) methodology in pharmacy practice settings has increased recently. However, its applications can vary significantly within a region, hence affecting the quality of the SP methodology. Objective: The purpose of this systematic review is to critically assess the use of the SP methodology for assessing the practice of community pharmacists (CP) in the Middle East and North Africa (MENA) region. Methods: A comprehensive literature search was conducted using EMBASE, MEDLINE, ProQuest, and SCOPUS to identify articles published from 2011 to 2022. The selection of relevant studies for inclusion in the systematic review was based on the pre-determined inclusion criteria. The Mixed Method Appraisal Tool (MMAT) was used to assess the methodological quality of the included studies. Results: Electronic search yielded 478 publications. A total of 45 studies were reviewed. The studies were conducted in 12 countries of the MENA region. The sample size between the reviewed articles ranged from 20 to 1000 (median= 129). A greater number of the included studies measured the adequacy of skill (pre-dispensing and/or post-dispensing) 38 (84.4%). The vast majority of the studies reported unsatisfactory results regarding the competencies of CP. The number of the SP ranged from 1 to 37 (median= 2). Most of the studies recruited only one SP per pharmacy 35 (77.8%). The most common data collection method was written data collection form 42 (93.3%). Few studies only had a detection system for SP visits 11 (24.4%), and only six studies incorporated performance feedback (13.3%). More than two-thirds of the studies provided a training session for SP 37 (82.2%). There was variation in the symptoms and drugs used in the SP scenarios in the studies. Conclusion: Although the results demonstrate the growth in the use of the SP method in MENA region countries, studies showed high variability in the level of reporting the study methodology. Consequently, we argue the need for standardized reporting of these studies.

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1. Sadek MM, Elnour AA, Al Kalbani NM, et al. Community pharmacy and the extended community pharmacist practice roles:The UAE experiences. 2016;24(5):563-570.
2. Rayes IK, Hassali MA, Abduelkarem ARJSPJ. The role of pharmacists in developing countries: the current scenario in the United Arab Emirates. 2015;23(5):470-474.
3. George PP, Molina JA, Cheah J, et al. The evolving role of the community pharmacist in chronic disease management-a literature review. 2010;39(11):861-867.
4. Puspitasari HP, Aslani P, Krass IJRiS. A review of counseling practices on prescription medicines in community pharmacies. Res Social Adm Pharm. 2009;5(3):197-210.
5. Horvat N, Koder M, Kos MJPO. Using the simulated patient methodology to assess paracetamol-related counselling for headache. Plos One. 2012;7(12):e52510.
6. Mesquita AR, Lyra Jr DP, Brito GC, et al. Developing communication skills in pharmacy: a systematic review of the use of simulated patient methods. Patient Educ Couns. 2010;78(2):143-148.
7. Watson MC, Cleland JA, Bond CMJFp. Simulated patient visits with immediate feedback to improve the supply of over-thecounter medicines: a feasibility study. Fam Pract. 2009;26(6):532-542.
8. Xu T, de Almeida Neto AC, Moles RJJIJoPP. A systematic review of simulated‐patient methods used in community pharmacy to assess the provision of non‐prescription medicines. Int J Pharm Pract. 2012;20(5):307-319.
9. Cohen MM, Dunn S, Cockerill R, et al. Using a secret shopper to evaluate pharmacist provision of emergency contraception: satisfaction levels high, with privacy a concern. 2004;137(1):28-33.
10. Watson MC, Norris P, Granas AJIJoPP. A systematic review of the use of simulated patients and pharmacy practice research. 2006;14(2):83-93.
11. Mesquita AR, Lyra Jr DP, Brito GC, et al. Developing communication skills in pharmacy: a systematic review of the use of simulated patient methods. Patient education counseling. 2010;78(2):143-148.
12. Xu T, de Almeida Neto AC, Moles RJ. A systematic review of simulated-patient methods used in community pharmacy to assess the provision of non-prescription medicines. International Journal of Pharmacy Practice. 2012;20(5):307-319.
13. Watson MC, Norris P, Granas A. A systematic review of the use of simulated patients and pharmacy practice research. International Journal of Pharmacy Practice. 2006;14(2):83-93.
14. Björnsdottir I, Granas AG, Bradley A, et al. A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016. International Journal of Pharmacy Practice. 2020;28(1):13-25.
15. Björnsdottir I, Granas AG, Bradley A, et al. A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016. Int J Pharm Pract. 2020;28(1):13-25.
16. Hong QN, Pluye P, Fàbregues S, et al. Mixed methods appraisal tool (MMAT), version 2018. Registration of copyright. 2018;1148552:10.
17. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.BMJ. 2021;372:n71.
18. Al-Faham Z, Habboub G, Takriti F. The sale of antibiotics without prescription in pharmacies in Damascus, Syria. The Journal of Infection in Developing Countries. 2011;5(05):396-399.
19. Alomar MJ, Qandil S, Al-Hilwani HM, et al. Evaluation of the community pharmacist’s behavior towards a prescription of antidiabetic and antiasthma drugs. Pharmacy practice. 2011;9(1):37-43.
20. Khan TM, Azhar S. A study investigating the community pharmacist knowledge about the appropriate use of inhaler, Eastern Region AlAhsa, Saudi Arabia. Saudi Pharmaceutical Journal. 2012;21(2):153-157.
21. Osman A, Hassan ISA, Ibrahim MIM. Are Sudanese community pharmacists capable to prescribe and demonstrate asthma inhaler devices to patrons? A mystery patient study. Pharmacy Practice-Granada. 2012;10(2):110.
22. Alaqeel S, Abanmy NO. Counselling practices in community pharmacies in Riyadh, Saudi Arabia: a cross-sectional study. BMC health services research. 2015;15:557.
23. Al-Worafi YM. Appropriateness of metered-dose inhaler use in the Yemeni community pharmacies. Journal of Taibah University Medical Sciences. 2015;10(3):353-358.
24. Kashour TS, Joury A, Alotaibi AM, et al. Quality of assessment and counselling offered by community pharmacists and medication sale without prescription to patients presenting with acute cardiac symptoms: A simulated client study. European Journal of Clinical Pharmacology. 2015;72(3):321-328.
25. Foroutan N, Dabaghzadeh F. Evaluating the practice of iranian community pharmacists regarding oral contraceptive pills using simulated patients. Pharmacy practice. 2016;14(4):745.
26. Ibrahim MIBM, Palaian S, Al-Sulaiti F, et al. Evaluating community pharmacy practice in Qatar using simulated patient method: Acute gastroenteritis management. Pharmacy practice. 2016;14(4).
27. Atia AE, Abired AN. Antibiotic prescribing for upper respiratory tract infections by Libyan community pharmacists and medical practitioners: An observational study. Libyan Journal of Medical Sciences. 2017;1(2):31.
28. Dabaghzadeh F, Hajjari R. Practice of community pharmacists related to multivitamin supplements: a simulated patient study in Iran. International Journal of Clinical Pharmacy. 2017;40(1):190-195.
29. Mohamed Ibrahim MI, Awaisu A, Palaian S, et al. Do community pharmacists in Qatar manage acute respiratory conditions rationally? A simulated client study. Journal of Pharmaceutical Health Services Research. 2017;9(1):33-39.
30. Paravattil B, Kheir N, Yousif A. Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar. International journal of clinical pharmacy. 2017;39(4):759-768.
31. Hammad EA, Elayeh E, Tubeileh R, et al. A simulated patient study assessing over the counter supply and counseling in Jordan:responding to headache complaints. International Journal of Clinical Pharmacy. 2018;40(5):982-986.
32. Ibrahim IR, Palaian S, Ibrahim MI. Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad,Iraq: A simulated patient study. Pharmacy practice. 2018;16(4):1313.
33. Mahmoud AA, Althobaiti OA, Althobaiti AE, et al. Community pharmacists’ response to acute back pain: A simulated patient study in western region, Saudi Arabia. GSC Biological Pharmaceutical Sciences. 2018;2(2).
34. Mikhael EM, Hassali MA, Hussain SA, et al. Assessment of pharmacist’s role in counselling and educating diabetic patients about insulin therapy. International Research Journal of Pharmacy. 2018;9(7):65-68.
35. Zolezzi M, Abdallah O, Kheir N, et al. Evaluation of community pharmacists’ preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients. Research in Social & Administrative Pharmacy : RSAP. 2018;15(3):252-259.
36. Abdelaziz AI, Tawfik AG, Rabie KA, et al. Quality of community pharmacy practice in antibiotic self-medication encounters: A simulated patient study in upper Egypt. Antibiotics. 2019;8(2).
37. Al-Worafi YM, Alseragi WM, Mahmoud MA. Competency of metered-dose inhaler use among community pharmacy dispensers in Ibb, Yemen: A simulation method study. Latin American Journal of Pharmacy. 2019;38(3):489-494.
38. Elayeh ER, Hammad EA, Tubeileh RH, et al. Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan. Pharmacy practice. 2019;17(4). PharmPract.2019.4.1661
39. Khojah HM. Privacy level in private community pharmacies in Saudi Arabia: A simulated client survey. Pharmacology Pharmacy. 2019;10(10):445.
40. Khojah HMJ. Do pharmacists counsel customers about the effects of sedating antihistamines on driving skills? A survey of community pharmacies in Saudi Arabia. Journal of International Medical Research. 2019;47(5):2018-2025.
41. Mobark DM, Al-Tabakha MM, Hasan S. Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the united arab emirates: A simulated patient study. Pharmacy practice. 2019;17(2):1465.
42. Wazaify M, Elayeh E, Tubeileh R, et al. Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach. PLoS ONE. 2019;14(12):e0226076. 
43. Yaacoub SG, Koyess V, Lahoud N, et al. Antibiotic prescribing for acute uncomplicated cystitis in Lebanese community pharmacies using a simulated patient. Pharmacy practice. 2019;17(4).
44. Yaacoub SG, Lahoud NA, Francis NJ, et al. Antibiotic prescribing rate in lebanese community pharmacies: a nationwide patient-simulated study of acute bacterial rhinosinusitis. Journal of Epidemiology Global Health. 2019;9(1):44. https://doi. org/10.2991/jegh.k.190305.001
45. Al Qarni H, Alrahbini T, AlQarni AM, et al. Community pharmacist counselling practices in the Bisha health directorate, Saudi Arabia -simulated patient visits. BMC Health Serv Res. 2020;20(1):745.
46. Al-Amad SH, Ghebeh M, Saloum P, et al. Pharmacists’ clinical competency towards oral mucosal diseases: Results from a mystery shopper study. Oral Dis. 2020;26(1):89-95.
47. Al-Tannir M, Altannir Y, Altannir M, et al. Community pharmacy sales of non-prescribed antibiotics in Riyadh, Saudi Arabia: a simulated patient study. International Journal of Clinical Pharmacy. 2020;42(2):341-346. 01033-0
48. Atia A. Information provided to customers about over-the-counter medications dispensed in community pharmacies in Libya:A crosssectional study. Eastern Mediterranean Health Journal. 2020;26(7):828-33.
49. Halboup A, Abdi A, Ahmed M, Al-Qadasi F, Othman GQ. Access to antibiotics without prescription in community pharmacies in Yemen during the political conflict. Public Health. 2020;183:30-35.
50. Palaian S, Buabeid M, Ashames A. Patient Safety Culture in Handling Prescriptions and Interprofessional Collaboration Practices Amongst Community Pharmacists: An Investigative Simulated Patient Study from the United Arab Emirates. Risk Management Healthcare Policy. 2020;13:3201.
51. Rashid ZA, Al-Tabakha MM, Alomar MJ. Proper Counseling and Dispensing of Isotretinoin Capsule Products by Community Pharmacists in UAE: A Simulated Patient Study. Clinical, cosmetic and investigational dermatology. 2020;13:405-414.
52. Soltani D, Ebrahimpour S, Hajimiri SH, et al. Assessment of antibiotic dispensing practice in community pharmacies oftehran, for 2 common infectious symptoms, using simulated patient method. Iranian Journal of Pharmaceutical Research. 2020;19(4):35-43.
53. Al-Qudah RA, Farha RA, Al Ali MM, et al. Evaluation of community pharmacists’ professional practice and management of patient’s respiratory conditions. Journal of Pharmacy and Bioallied Sciences. 2021;13(2):212-219.
54. Hamadouk RM, Arbab AH, Yousef BA. Assessment of community pharmacist’s practice and patient counselling toward acute diarrhea treatment in khartoum locality: A simulated patient study. Integrated Pharmacy Research and Practice. 2021;10:145- 152.
55. Hasan S, Al Oum L, Hassan NAG. A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma. Journal of Pharmaceutical Policy and Practice. 2021;14(1).
56. Itani R, Khojah HMJ, Jaffal F, et al. Provision of pharmaceutical care to suspected high-risk COVID-19 patients through telehealth: a nationwide simulated patient study. BMC health services research. 2021;21(1):997. (eISSN: 1886-3655 ISSN: 1885-642X)
57. Tawfik AG, Abdelaziz AI, Omran M, et al. Assessment of community pharmacy management towards self-medication requests of tetracyclines for pregnant women: a simulated client study in Upper Egypt. International Journal of Clinical Pharmacy. 2021;43(4):969-979.
58. Alzubaidi H, Austin Z, Saidawi W, et al. Exploring the quality of smoking cessation in community pharmacies: A simulatedpatient study. Research in social & administrative pharmacy : RSAP. 2022;18(6):2997-3003.
59. Hamadouk RM, Albashair ED, Mohammed FM, et al. The Practice of the Community Pharmacists in Managing Potential Drug-Drug Interactions: A Simulated Patient Visits. Integrated Pharmacy Research and Practice. 2022;11:71-84.
60. Hammad EA, Al-Aqeel S, Elayah E, et al. Assessing content and factors influencing responses to information requests in  community pharmacies in Jordan: A simulated patients study. Plos one. 2022;17(2):e0264224.
61. Hammad EA, Elayeh E, Jaber D, et al. Feasibility of using simulated patients for onsite structured practice feedback in Jordanian community pharmacy settings. Saudi Pharmaceutical Journal. 2022;30(3):225-229.
62. Karout S, Khojah HMJ, Itani R, et al. Assessing the pharmaceutical care provision to suspected COVID-19 patients in community pharmacies: a simulated patient study. BMC health services research. 2022;22(1):467.
63. Aloudah N, Alhumsi A, Alobeid N, et al. Factors impeding the supply of over-the-counter medications according to evidencebased
practice: A mixed-methods study. PLoS One. 2020;15(11):e0240913.
64. Rosner B. Fundamentals of Biostatistics (The 7th edition): Boston, MA: Brooks/Cole; 2011.
65. Dornyei Z. Research Methods in Applied Linguistics Oxford University Press; 2007.
66. Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling and purposive sampling. American Journal of Theoretical Applied Statistics. 2016;5(1):1-4.
67. Norja R, Karlsson L, Antfolk J, et al. How old was she? The accuracy of assessing the age of adolescents’ based on photos. Nordic Psychology. 2022;74(1):70-85.
68. Muller A, Sirianni LA, Addante RJ. Neural correlates of the Dunning–Kruger effect. European Journal of Neuroscience.2021;53(2):460-484.
69. Einarson TR, Sokar-Todd HB. Community pharmacy practice research: a systematic review of the past 32 years. Canadian Pharmacists Journal. 2003;136(8):26.
70. Douglas J. Mystery shoppers: an evaluation of their use in monitoring performance. The TQM Journal. 2015.

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